Dermatologic Manifestations of Enteroviral Infections Workup

  • Author: Susanna Nogués-Siuraneta, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 12, 2010
 

Laboratory Studies

Enteroviral infections are diagnosed mainly on the basis of clinical features; however, a specific diagnosis of enterovirus infection requires detection of the virus in patient samples. In some cases, complementary tests may be useful.

  • Serologic studies
    • The detection of virus-specific immunoglobulin M (IgM) antibodies by means of enzyme-linked immunosorbent assay can aid diagnosis; however, because it is time-consuming to obtain results using this technique, it may be of limited value in a clinical setting.
    • Serum samples should be obtained during the acute phase of the disease because IgM antibodies rapidly disappear.
    • The antibodies are usually group specific and not type specific.
    • No universal antibody or antigen assay exists because no single antigen is present in all enterovirus serotypes.[2]
    • Serology has no role in routine diagnosis.
  • Cell culture
    • Cell culture may allow isolation of the virus.
    • Samples may be obtained from the blood, stool, pharyngeal secretions, or vesicular fluid. Some reports suggest that the best results are achieved when samples are collected from the upper respiratory tract, gastrointestinal tract, or cerebrospinal fluid.[2]
    • The most specific findings are found in samples from blood and blister fluid. Findings in fecal specimens are least specific because enteroviruses may be shed for weeks after acute infection and can be detected well after the clinical illness has resolved. A 2007 study revealed that a throat culture plus a culture of 2 sterile vesicles (or from the rectum if no sterile vesicles are present) may have the highest yield for detecting enterovirus 71 in persons with hand-foot-and-mouth disease (HFMD).[17]
    • Although enteroviruses take 4-8 days to grow and results are usually not available in sufficient time to impact treatment of the patient, culture remains an important epidemiologic tool. Viral culture allows the clinician to isolate and identify the serotype of the virus causing disease.
  • Polymerase chain reaction
    • The reverse transcriptase polymerase chain reaction (PCR) has made enteroviral subtyping possible and has increase the enterovirus detection rate, especially in the analysis of cerebrospinal fluid.
    • PCR techniques require small amounts of clinical material and are rapid (within 5-24 h of receipt of the sample), sensitive, and specific. PCR is superior to viral culture for the diagnosis of many enterovirus infections, particularly enteroviral meningitis.[18] Specimen sources are the same as those for cell cultures, as outlined above.
    • Commercial enterovirus PCR tests are available.
    • Because of their extreme sensitivity, PCR tests are subject to false-positive results due to contamination and to false-negative results due to levels below assay detection.
    • Enterovirus PCR provides the potential for a reduction in unnecessary hospitalization and diagnostic or therapeutic interventions.
    • Real-time RT-PCR assays permit shorter turnover times, especially for the detection of enterovirus RNA.[19]
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Histologic Findings

In most cases, histopathologic findings are nonspecific and are not necessary for diagnosis.

When histopathologic examination is performed to evaluate HFMD, findings may include spongiosis, intraepidermal vesicles that contain neutrophils and mononuclear cells, and some necrotic keratinocytes.[20, 21, 22] Edema and a perivascular infiltrate composed of lymphocytes and neutrophils may be seen in the dermis.

In eruptive pseudoangiomatosis (EP), lesions are composed of dilated superficial vessels with plump endothelial cells. The lesions are easily distinguished from true angiomas because the number of vessels is not increased.

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Contributor Information and Disclosures
Author

Susanna Nogués-Siuraneta, MD  Resident, Department of Dermatology, Hospital Clinic de Barcelona

Disclosure: Nothing to disclose.

Coauthor(s)

Mercè Alsina-Gibert, MD  Consultant, Department of Dermatology, Hospital Clinic, Spain

Disclosure: Nothing to disclose.

Steven Brett Sloan, MD  Assistant Professor, Department of Dermatology, University of Connecticut School of Medicine; Director of Nail Disease Clinic and Chief of Dermatology, Newington Veterans Affairs Medical Center

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Connecticut State Medical Society, New England Dermatological Society, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Pelle, MD  Clinical Assistant Professor, Division of Dermatology, Department of Medicine, University of California at San Diego

Michelle Pelle, MD is a member of the following medical societies: American Academy of Dermatology, California Medical Association, Medical Dermatology Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Erosions on the base of the tongue.
A red halo surrounds several vesicles on the finger flexures and palms.
Small linear vesicle on the thumb.
Vesicle on the dorsal hand of a young adult.
 
 
 
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